When chemotherapy isn’t the answer...

When should a breast cancer patient go for chemotherapy?

Worldwide, about two million breast cancer patients are diagnosed every year, and India accounts for about 1,50,000 patients per year out of it. Breast cancer has four stages: stage 1 and 2 are called as ‘early stage’, currently accounting for about 50% of the total in India. For an early-stage breast cancer patient, the cancer is contained and has not spread to other areas. In most cases, the primary tumour is removed surgically. Post-surgery, doctors create a treatment plan based on the risk of recurrence. Post-operative chemotherapy is recommended only for those patients who have a ‘high risk’ of cancer recurrence.

Studies have shown that the rate of recurrence in early-stage breast cancer patients is low. This indicates that a vast majority of these patients receive little to no benefit from the addition of chemotherapy to their treatment regimen. Thus, a majority of patients treated with chemotherapy have to bear the toxic effects of the treatment which reduces the quality of life, and can be a monetary drain for the patient.

However, there is minimal awareness about the tests that can accurately predict the recurrence of cancer. Tests which predict ‘risk of recurrence’ exist in the West and have helped many early-stage patients in deciding the optimal course of therapy. However, these tests are prohibitively expensive for Asian patients and are not well-validated on patients from Southeast Asia.

Affordable tests that are well-validated on Indian patients is a growing medical need. To address this need, scientists in India are developing innovative multi-marker prognostic tests to personalise treatments for breast cancer patients. Patients classified as ‘high-risk’ would have a greater probability of cancer recurring than those classified as low-risk. This will help clinicians and the patients to understand the disease better and plan a suitable treatment.

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